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BMC Public Health
Published in: BMC Public Health 1/2013

Open Access 01-12-2013 | Research article

Health promotion in individuals with mental disorders: a cluster preference randomized controlled trial

Authors: Nick Verhaeghe, Els Clays, Carine Vereecken, Jan De Maeseneer, Lea Maes, Cornelis Van Heeringen, Dirk De Bacquer, Lieven Annemans

Published in: BMC Public Health | Issue 1/2013

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Abstract

Background

The existing literature on weight management interventions targeting physical activity and healthy eating in mental health care appears to provide only limited evidence. The aim of the study was to examine the effectiveness of a 10-week health promotion intervention, followed by a 6-month follow-up period in individuals with mental disorders living in sheltered housing in the Flanders region (Belgium).

Methods

The study had a cluster preference randomized controlled design. Twenty-five sheltered housing organisations agreed to participate (16 in the intervention group, nine in the control group). In the intervention group, 225 individuals agreed to participate, while in the control group 99 individuals entered into the study. The main outcomes were changes in body weight, Body Mass Index, waist circumference and fat mass. Secondary outcomes consisted of changes in physical activity levels, eating habits, health-related quality of life and psychiatric symptom severity.

Results

A significant difference was found between the intervention group and the control group regarding body weight (−0.35 vs. +0.22 kg; p=0.04), Body Mass Index (−0.12 vs. +0.08 kg/m2; p=0.04), waist circumference (−0.29 vs. + 0.55 cm; p<0.01), and fat mass (−0.99 vs. −0.12%; p<0.01). The decrease in these outcomes in the intervention group disappeared during the follow up period, except for fat mass. Within the intervention group, a larger decrease in the primary outcomes was found in the participants who completed the intervention. No significant differences between the two groups in changes in the secondary outcomes were found, except for the pedometer-determined steps/day. In the intervention group, the mean number of daily steps increased, while it decreased in the control group.

Conclusions

The study demonstrated that small significant improvements in the primary outcomes are possible in individuals with mental disorders. Integration of health promotion activities targeting physical activity and healthy eating into daily care are, however, necessary to maintain the promising results.

Trial registration

This study is registered at ClinicalTrials.gov NCT01336946
Appendix
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Literature
1.
Dickerson FB, Brown CH, Kreyenbuhl JA, Fang L, Goldberg RW, Wohlheiter K, et al: Obesity among individuals with serious mental illness. Acta Psychiatr Scand. 2006, 113: 306-313. 10.1111/j.1600-0447.2005.00637.x.CrossRefPubMed
2.
Limosin F, Gasquet I, Leguay D, Azorin JM, Rouillon F: Body mass index and prevalence of obesity in a French cohort of patients with schizophrenia. Acta Psychiatr Scand. 2008, 118: 19-25. 10.1111/j.1600-0447.2008.01208.x.CrossRefPubMed
3.
Scott D, Happell B: The high prevalence of poor physical health and unhealthy lifestyle behaviours in individuals with severe mental illness. Issues Ment Health Nurs. 2011, 32: 589-597. 10.3109/01612840.2011.569846.CrossRefPubMed
4.
Fagiolini A, Goracci A: The effects of undertreated chronic medical illnesses in patients with severe mental disorders. J Clin Psychiatry. 2009, 70 (Suppl 3): 22-29. 10.4088/JCP.7075su1c.04.CrossRefPubMed
5.
Osborn DP, Nazareth I, King MB: Risk for coronary heart disease in people with severe mental illness: cross-sectional comparative study in primary care. Br J Psychiatry. 2006, 188: 271-277. 10.1192/bjp.bp.104.008060.CrossRefPubMed
6.
Brown S, Kim M, Mitchell C, Inskip H: Twenty-five year mortality of a community cohort with schizophrenia. Br J Psychiatry. 2010, 196: 116-121. 10.1192/bjp.bp.109.067512.CrossRefPubMedPubMedCentral
7.
Osby U, Brandt L, Correia N, Ekbom A, Sparen P: Excess mortality in bipolar and unipolar disorder in Sweden. Arch Gen Psychiatry. 2001, 58: 844-850. 10.1001/archpsyc.58.9.844.CrossRefPubMed
8.
Allison DB, Casey DE: Antipsychotic-induced weight gain: a review of the literature. J Clin Psychiatry. 2001, 62 (Suppl 7): 22-31.PubMed
9.
Parsons B, Allison DB, Loebel A, Williams K, Giller E, Romano S, et al: Weight effects associated with antipsychotics: a comprehensive database analysis. Schizophr Res. 2009, 110: 103-110. 10.1016/j.schres.2008.09.025.CrossRefPubMed
10.
Nyboe L, Lund H: Low levels of physical activity in patients with severe mental illness. Nord J Psychiatry. 2013, 67: 43-46. 10.3109/08039488.2012.675588.CrossRefPubMed
11.
Osborn DP, Nazareth I, King MB: Physical activity, dietary habits and Coronary Heart Disease risk factor knowledge amongst people with severe mental illness: a cross sectional comparative study in primary care. Soc Psychiatry Psychiatr Epidemiol. 2007, 42: 787-793. 10.1007/s00127-007-0247-3.CrossRefPubMed
12.
Ussher M, Doshi R, Sampuran A, West R: Cardiovascular risk factors in patients with schizophrenia receiving continuous medical care. Community Ment Health J. 2011, 47: 688-693. 10.1007/s10597-011-9376-y.CrossRefPubMed
13.
Henderson DC, Borba CP, Daley TB, Boxill R, Nguyen DD, Culhane MA, et al: Dietary intake profile of patients with schizophrenia. Ann Clin Psychiatry. 2006, 18: 99-105. 10.1080/10401230600614538.CrossRefPubMed
14.
McCreadie RG: Diet, smoking and cardiovascular risk in people with schizophrenia: descriptive study. Br J Psychiatry. 2003, 183: 534-539. 10.1192/bjp.183.6.534.CrossRefPubMed
15.
Roick C, Fritz-Wieacker A, Matschinger H, Heider D, Schindler J, Riedel-Heller S, et al: Health habits of patients with schizophrenia. Soc Psychiatry Psychiatr Epidemiol. 2007, 42: 268-276. 10.1007/s00127-007-0164-5.CrossRefPubMed
16.
Brown S, Birtwistle J, Roe L, Thompson C: The unhealthy lifestyle of people with schizophrenia. Psychol Med. 1999, 29: 697-701. 10.1017/S0033291798008186.CrossRefPubMed
17.
Strassnig M, Brar JS, Ganguli R: Nutritional assessment of patients with schizophrenia: a preliminary study. Schizophr Bull. 2003, 29: 393-397. 10.1093/oxfordjournals.schbul.a007013.CrossRefPubMed
18.
Clark M, Hampson SE, Avery L, Simpson R: Effects of a tailored lifestyle self-management intervention in patients with type 2 diabetes. Br J Health Psychol. 2004, 9: 365-379. 10.1348/1359107041557066.CrossRefPubMed
19.
Eriksson KM, Westborg CJ, Eliasson MC: A randomized trial of lifestyle intervention in primary healthcare for the modification of cardiovascular risk factors. Scand J Public Health. 2006, 34: 453-461. 10.1080/14034940500489826.CrossRefPubMed
20.
Lowe T, Lubos E: Effectiveness of weight management interventions for people with serious mental illness who receive treatment with atypical antipsychotic medications. A literature review. J Psychiatr Ment Health Nurs. 2008, 15: 857-863. 10.1111/j.1365-2850.2008.01337.x.CrossRefPubMed
21.
Federal Public Service Health FCSaE: Health Care Facilities. 2011, Brussels: Federal Public Service Health FCSaE
22.
Anthony W, Ohen M, Farkas M, Gagne C: Psychiatric rehabilitation. 2002, Boston: Center for Psychiatric Rehabilitation, Boston University, 2
23.
Howard L, Thornicroft G: Patient preference randomised controlled trials in mental health research. Br J Psychiatry. 2006, 188: 303-304. 10.1192/bjp.188.4.303.CrossRefPubMed
24.
Shapiro SL, Figueredo AJ, Caspi O, Schwartz GE, Bootzin RR, Lopez AM, et al: Going quasi: the premature disclosure effect in a randomized clinical trial. J Behav Med. 2002, 25: 605-621. 10.1023/A:1020693417427.CrossRefPubMed
25.
26.
Bandura A: Health promotion by social cognitive means. Health Educ Behav. 2004, 31: 143-164. 10.1177/1090198104263660.CrossRefPubMed
27.
Ryan RM, Deci EL: Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000, 55: 68-78.CrossRefPubMed
28.
Carver CS, Scheier MF: Control theory: a useful conceptual framework for personality-social, clinical, and health psychology. Psychol Bull. 1982, 92: 111-135.CrossRefPubMed
29.
Flemish Institute of Health Promotion and Disease Prevention: Manual Health Promotion: Healthy eating and physical activity. 2007, Brussels: Flemish Institute of Health Promotion and Disease Prevention
30.
Verhaeghe N, De MJ, Maes L, Van HC, Annemans L: Effectiveness and cost-effectiveness of lifestyle interventions on physical activity and eating habits in persons with severe mental disorders: a systematic review. Int J Behav Nutr Phys Act. 2011, 8: 28-10.1186/1479-5868-8-28.CrossRefPubMedPubMedCentral
31.
Hayes RJ, Bennett S: Simple sample size calculation for cluster-randomized trials. Int J Epidemiol. 1999, 28: 319-326. 10.1093/ije/28.2.319.CrossRefPubMed
32.
Kaiser R, Woodruff BA, Bilukha O, Spiegel PB, Salama P: Using design effects from previous cluster surveys to guide sample size calculation in emergency settings. Disasters. 2006, 30: 199-211. 10.1111/j.0361-3666.2006.00315.x.CrossRefPubMed
33.
National Heart Lung and Blood Institute: Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. The Evidence Report. 1998, Bethesda: National Institues of Health
34.
Vandelanotte C, De Bourdeaudhuij I, Philippaerts R, Sjöström M, Sallis J: Reliability and validity of a computerized and Dutch version of the International Physical Activity Questionnaire (IPAQ). J Phys Act Health. 2005, 2: 63-75.
35.
Crouter SE, Schneider PL, Karabulut M, Bassett DR: Validity of 10 electronic pedometers for measuring steps, distance, and energy cost. Med Sci Sports Exerc. 2003, 35: 1455-1460. 10.1249/01.MSS.0000078932.61440.A2.CrossRefPubMed
36.
Vereecken CA, Covents M, Haynie D, Maes L: Feasibility of the Young Children’s Nutrition Assessment on the Web. J Am Diet Assoc. 2009, 109: 1896-1902. 10.1016/j.jada.2009.08.013.CrossRefPubMedPubMedCentral
37.
Vereecken C, Dohogne S, Covents M, Maes L: How accurate are adolescents in portion-size estimation using the computer tool Young Adolescents’ Nutrition Assessment on Computer (YANA-C)?. Br J Nutr. 2010, 103: 1844-1850. 10.1017/S0007114510000127.CrossRefPubMed
38.
Ware JE, Snow KK, Kosinski M, Gandek B: SF-36 Health Survey: Manual and Interpretation Guide. 1993, Boston, MA: Nimrod Press
39.
Derogatis LR, Melisaratos N: The Brief Symptom Inventory: an introductory report. Psychol Med. 1983, 13: 595-605. 10.1017/S0033291700048017.CrossRefPubMed
40.
de Beurs E, Zitman F: De Brief Symptom Inventory (BSI): De betrouwbaarheid en validiteit van een handzaam alternatief voor de SCL-90. 2005, Leiden: Leids Universitair Medisch Centrum
41.
Sterne JA, White IR, Carlin JB, Spratt M, Royston P, Kenward MG, et al: Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ. 2009, 338: b2393-10.1136/bmj.b2393.CrossRefPubMedPubMedCentral
42.
Hox JJ: Multilevel analysis: Techniques and Applications. 2010, New York: Routledge, 2
43.
Van der Heyden J, Gisle L, Demarest S, Drieskens S, Hesse E, Tafforeau J: Health Interview Survey Belgium 2008. 2010, Brussels: Scientific Institute for Public Health
44.
NICE: Obesity: Guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children. 2006, London: National Institute for Health and Clinical Excellence
45.
U.S.Department of Health and Human Services: 2008 Physical Activity Guidelines for Americans. 2008, Washington: U.S.Department of Health and Human Services
46.
World Health Organization: Global strategy on diet, physical activity and health. 2004, Geneva: World Health Organization
47.
De Hert M, Dekker JM, Wood D, Kahl KG, Holt RI, Moller HJ: Cardiovascular disease and diabetes in people with severe mental illness position statement from the European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC). Eur Psychiatry. 2009, 24: 412-424. 10.1016/j.eurpsy.2009.01.005.CrossRefPubMed
48.
Chacon F, Mora F, Gervas-Rios A, Gilaberte I: Efficacy of lifestyle interventions in physical health management of patients with severe mental illness. Ann Gen Psychiatry. 2011, 10: 22-10.1186/1744-859X-10-22.CrossRefPubMedPubMedCentral
49.
Cabassa LJ, Ezell JM, Lewis-Fernandez R: Lifestyle interventions for adults with serious mental illness: a systematic literature review. Psychiatr Serv. 2010, 61: 774-782. 10.1176/appi.ps.61.8.774.CrossRefPubMedPubMedCentral
50.
Robson D, Gray R: Serious mental illness and physical health problems: a discussion paper. Int J Nurs Stud. 2007, 44: 457-466. 10.1016/j.ijnurstu.2006.07.013.CrossRefPubMed
51.
Rychetnik L, Frommer M, Hawe P, Shiell A: Criteria for evaluating evidence on public health interventions. J Epidemiol Community Health. 2002, 56: 119-127. 10.1136/jech.56.2.119.CrossRefPubMedPubMedCentral
52.
Christie J, O’Halloran P, Stevenson M: Planning a cluster randomized controlled trial: methodological issues. Nurs Res. 2009, 58: 128-134. 10.1097/NNR.0b013e3181900cb5.CrossRefPubMed
53.
Taljaard M, Weijer C, Grimshaw JM, Belle BJ, Binik A, Boruch R, et al: Ethical and policy issues in cluster randomized trials: rationale and design of a mixed methods research study. Trials. 2009, 10: 61-10.1186/1745-6215-10-61.CrossRefPubMedPubMedCentral
54.
Macias C, Gold PB, Hargreaves WA, Aronson E, Bickman L, Barreira PJ, et al: Preference in random assignment: implications for the interpretation of randomized trials. Adm Policy Ment Health. 2009, 36: 331-342. 10.1007/s10488-009-0224-0.CrossRefPubMedPubMedCentral
55.
Casey D: Nurses’ perceptions, understanding and experiences of health promotion. J Clin Nurs. 2007, 16: 1039-1049. 10.1111/j.1365-2702.2007.01640.x.CrossRefPubMed
56.
Jormfeldt H, Svedberg P, Arvidsson B: Nurses’ conceptions of how health processes are promoted in mental health nursing. J Psychiatr Ment Health Nurs. 2003, 10: 608-615. 10.1046/j.1365-2850.2003.00642.x.CrossRefPubMed
57.
Department of Health: Care pathway for the management of overweight and obesity. 2006, London: Department of Health London
58.
Verhaeghe N, De MJ, Maes L, Van HC, Annemans L: Health promotion in mental health care: perceptions from patients and mental health nurses. J Clin Nurs. 2013, 22: 1569-1578. 10.1111/jocn.12076.CrossRefPubMed
59.
Federal Public Service Health FCSaE: Feedback MPG 2009. 2012, Brussels: Federal Public Service Health,Food Chain Safety and Environment
60.
McDevitt J, Snyder M, Miller A, Wilbur J: Perceptions of barriers and benefits to physical activity among outpatients in psychiatric rehabilitation. J Nurs Scholarsh. 2006, 38: 50-55. 10.1111/j.1547-5069.2006.00077.x.CrossRefPubMed
61.
Shiner B, Whitley R, Van Citters AD, Pratt SI, Bartels SJ: Learning what matters for patients: qualitative evaluation of a health promotion program for those with serious mental illness. Health Promot Int. 2008, 23: 275-282. 10.1093/heapro/dan018.CrossRefPubMedPubMedCentral
62.
Ussher M, Stanbury L, Cheeseman V, Faulkner G: Physical activity preferences and perceived barriers to activity among persons with severe mental illness in the United Kingdom. Psychiatr Serv. 2007, 58: 405-408. 10.1176/appi.ps.58.3.405.CrossRefPubMed
63.
Rowe AK, Lama M, Onikpo F, Deming MS: Design effects and intraclass correlation coefficients from a health facility cluster survey in Benin. Int J Qual Health Care. 2002, 14: 521-523. 10.1093/intqhc/14.6.521.CrossRefPubMed
64.
Davidson S, Judd F, Jolley D, Hocking B, Thompson S, Hyland B: Cardiovascular risk factors for people with mental illness. Aust N Z J Psychiatry. 2001, 35: 196-202. 10.1046/j.1440-1614.2001.00877.x.CrossRefPubMed
65.
Mackin P, Bishop D, Watkinson H, Gallagher P, Ferrier IN: Metabolic disease and cardiovascular risk in people treated with antipsychotics in the community. Br J Psychiatry. 2007, 191: 23-29. 10.1192/bjp.bp.106.031716.CrossRefPubMed
Metadata
Title
Health promotion in individuals with mental disorders: a cluster preference randomized controlled trial
Authors
Nick Verhaeghe
Els Clays
Carine Vereecken
Jan De Maeseneer
Lea Maes
Cornelis Van Heeringen
Dirk De Bacquer
Lieven Annemans
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2013
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-13-657

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